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If you are thinking of leaving the profession, here’s some advice from those who have been there on how to gain fresh perspective
With a nursing vacancy rate of almost 11% in the NHS in England and about one in five of those who leave (18.3%) citing too much pressure as the reason, it is clear many nurses are unhappy at work and seeking alternatives.
Nursing Standard. 38, 8, 27-28. doi: 10.7748/ns.38.8.27.s14
Published: 02 August 2023
But is leaving the only choice if you find yourself in this situation, or is it possible to fall back in love with nursing?
‘I 100% believe that you can, because I’ve lived it,’ says Central London Community Healthcare NHS Trust lead professional nurse advocate (PNA) Martin Hogan*. ‘I’ve probably had 15 episodes in the past 22 years of feeling disillusioned and burnt-out.
‘Before I became a PNA, I wasn’t good at knowing what to do. Leaving and running away can feel like the only answer. But sometimes, sitting with it and remembering your passion for nursing and that it’s something you’ve always wanted to do can help.’
In his PNA role, Mr Hogan often supports people who are feeling so dispirited they don’t know what to do next. ‘It’s really brave to say I’ve had enough and can’t cope,’ he says.
At the outset, he starts to unpick what has led to those emotions, before moving on to what can change to make things better. He often uses Maslow’s hierarchy of needs to assess where people are. This motivational theory presents human needs in five categories that dictate behaviour – needs that form the basis of the hierarchy, such as physiological and safety needs, must be satisfied before individuals can attend to higher needs such as self-actualisation.
‘Often they are at survival or safety,’ he says. ‘I ask what they need to reach self-actualisation. Having the space to say, “I’m not okay”, followed by a conversation where we can explore everything is very powerful.’
Options may include improving their interview skills or taking a course, he says. ‘Lots of people do specific modules on topics such as quality improvement or end of life care. It’s making such a difference. They’re developing and investing in their betterment, which is giving them back their passion for the profession.’
Among Mr Hogan’s new initiatives at his trust is a ‘walkie talkie’ model of providing support, where he accompanies a community nurse on their way to their next patient.
‘As we all know, people don’t have time in their busy clinical roles,’ he says. ‘But a 20-minute walk to see their next patient means we can have a chat, a career conversation, supervision or just a well-being check-in. It’s been really beneficial.’
The trust is also starting an ‘itchy feet’ clinic, where people who want to try something new or are even considering leaving can chat through their thoughts and feelings with one of the trust’s PNAs.
Making small changes at work can have a big impact, he believes. For example, having a team chat at the end of a shift, before going home, can help everyone feel more positive.
‘It’s the simple things I’ve learned, often from not looking after myself,’ says Mr Hogan.
‘Doing the PNA course and learning about preventive mental health and setting boundaries made me realise I needed to put my own oxygen mask on first, before I put on anyone else’s.’
Talking to others who have felt similarly, including those in senior positions, can also be useful, Mr Hogan says.
‘You can get some sage advice. They’ve used different tools and tactics to recover. Those who have had similar experiences can be more compassionate and empathetic when you’re having a harder time, because they really get it.’
Health and well-being ambassador Jon Smith, a neuropsychiatry advanced nurse practitioner at the Walton Centre NHS Foundation Trust in Liverpool, is a big advocate of coaching.
‘I’ve done it and it really helped me,’ he says. ‘It allowed me to put things in perspective, figure out what was in my control and what wasn’t, and how I could move forward.’
Staff at his trust can access coaching confidentially, and Mr Smith had six sessions, held weekly.
‘It proved to me the value of raising your hand and saying, “I could do with some help”,’ he says. ‘Afterwards, I didn’t feel as bogged down by things.
‘Nurses have really challenging jobs and sometimes the day-to-day can affect all of us.’
Opportunities for training and development are also key to nurses feeling happier in their work, he believes. At the Walton Centre, standardised supervision templates prompt conversations on how staff can develop.
‘When we feel valued, that can be enough to have that career wake-up,’ says Mr Smith. ‘We’re much more in the right head space to get involved in training and development.’
Investing in your own well-being can help you make better choices about your future, Mr Smith says. ‘Getting outside in the fresh air, switching off after work and having a good night’s sleep can all put you in the right frame of mind to make positive changes,’ he says. ‘Get the basics right to start with, and they often help the bigger picture.’
Although Leonie Brown wasn’t disenchanted with nursing, she knew she wanted to try something new.
‘I’ve never fallen out of love with nursing,’ she says. ‘But things felt a bit flat, I was too comfortable in my role and I wanted something to keep me stimulated. I love learning and I wanted to learn new things.’
In February 2023, she began a one-year secondment as head for fundamentals of care at Epsom and St Helier University Hospitals NHS Trust. ‘I’m enjoying it and it aligns well with me,’ says Ms Brown, whose substantive post is charge nurse and education lead. ‘It gives me new challenges that are extending my potential.’
A chance to reinvigorate your career
This is Ms Brown’s second secondment, although the first, in 2021, was for just a month. This followed her completion of the Windrush Nurses and Midwives Leadership Programme, run by the Florence Nightingale Foundation to support the development of black, Asian and minority ethnic leaders.
‘I love a secondment,’ says Ms Brown. ‘It gives you the opportunity to check whether it’s the right place for you and you like the job. Secondments are good for learning and gaining more experience.’
They can also reinvigorate your career, she believes. ‘They can be the way forward. They help to build your confidence and make you believe in yourself.’
If you opt for a secondment but it turns out it is not for you, don’t despair or think you have failed, adds Ms Brown. ‘You can always return to your original post or choose another avenue and you’ll come back with some additional learning.’
For RCN Nurse of the Year 2020 Ana Waddington, a traumatic incident in 2022, involving a vulnerable young patient with mental health issues who attempted to take their own life, led to her questioning her future as a nurse.
‘It made me lose a little bit of hope on whether anything I was doing was doing any good,’ she says.
‘I’ve had to do a lot of work on understanding why it had such an impact on me. It shocked me just how broken the system was and how little control we have as individuals.’
As a result of seeking help from a psychologist, alongside talking to friends and colleagues, she now understands much more about what she needs to feel satisfied in her day-to-day life.
‘It was also everything that happened throughout the pandemic,’ says Ms Waddington, who was a paediatric critical care outreach nurse at the Royal London Hospital at the time.
‘We were constantly in a state of fight or flight.’ In 2019, she set up YourStance – a team of experienced doctors and nurses who teach life-saving skills to young people in London at risk of serious youth violence – and now has funding enabling her to work for the project for a few hours each week.
‘It’s been my absolute saviour, reinvigorating my passion for nursing and giving me a different perspective,’ says Ms Waddington.
In June, she started a part-time nine-month secondment to work with rough sleepers in an area of north London.
‘It’s an interesting and exciting role that means I can use all the skills I have now, as a result of the different things I’ve done,’ she says.
‘After all the trauma I’ve been through, I needed a fresh start.’
Further reading
*Turn to p55-56 for more on the professional nurse advocate role and Martin Hogan’s experience of it
Thinking of leaving the profession: the questions to ask to help you decide rcni.com/quitting-decision
